| Objective:As one of the most common primary headache disorders,migraine has brought great burden to patient's daily life.Chronic migraine has become the 7th disabling disease for its high frequency,long duration and high pain intensity.The treatment choices are quite limited and the most accepted therapeutic protocols are prophylactic application and analgesics for acute attacks combining with acupuncture,massage and other physiotherapy programs.However,the adverse effects of oral medicine and limitations of physiotherapy are troubling patients and physicians,Many patients adjust the dose or even stop the drug because of the economic and psychological burden by long-term oral medicines.Chronic migraine is the most widely used disease in the analgesia of botulinum toxin type A and the effect is obvious.But the application in China are still in the exploratory stage.The purpose of this study was to comprehensively evaluate the efficacy of botulinum toxin type A in the treatment of chronic migraine,so as to provide assistance for current options in China.Method:A total of 30 chronic migraines cases were involved at the Shandong Provincial Hospital from 2018.All the patients met the diagnostic criteria for chronic migraine.The open label method was accepted.The baseline information was recorded and then the fix-position and fix-dosage injection method was conducted.There were 21 points and total dose was 100u.Headache diary was distributed after injection and patients were required to make daily records.Data were evaluated at baseline(visit 1)and 3 consecutive follow up visits;at week 4(visit 2),week 8(visit 3),week 12(visit 4)to evaluate change from baseline to follow up.Kruskal-Wallis was used to test headache frequency and duration,number of analgesics used,Migraine Disability Assessment Scale scores and VAS scores.Fisher exact probability test was used to test the number of people using analgesics and Ridit analysis was used to test the headache intensity changes.Meanwhile,we recorded the incidence of postoperative complications.Result:A total of 30 patients showed improvements in the above indicators to varying degrees.Compared with preoperative,the reduction in headache frequency was statistically significant(P<0.05)and there was a significant difference between week 4 and week 8(P<0.05).The duration of headache was significantly reduced after treatment,which was statistically different from that before injection(P<0.05).VAS scores at week 4,week 8 and week 12 after surgery were significantly lower than those before surgery,and the difference was statistically significant(P<0.05).The dose of medicines and number of patients using painkillers after treatment were lower than before,and the difference was statistically significant(P<0.05).MIDAS score was significantly lower than the baseline level after three months,and the difference was statistically significant(P<0.05).Headache intensity was significantly decreased in patients with severe migraine,and correlation analysis of curative effect showed better effect in patients with severe migraine(P<0.05).There was no significant correlation between the ef:ficacy of botulinum toxin type A and gender,age and duration of disease(P>0.05).During the follow-up,5 patients had minor complications without serious adverse reactions,and the overall incidence of side effect was 16.67%.The significant effective rate was 60%and the overall effective rate was 83.3%.Conclusion:Botulinum toxin type A injection can reduce the frequency,duration,severity and use of painkillers of patients with chronic migraine,and the efficacy was maintained for at least three months.Botulinum toxin type A has better effect on severe headache,and the effect has no significant correlation with patients'gender,age,disease course and headache duration.Botulinum toxin type A injection has mild adverse reactions in the treatment of chronic migraine.There were no severe systemic adverse reactions,which is worthy of clinical promotion... |
PDF Full Text Request